Valoración del grado de afectación sobre la salud psíquica en el paciente prelaringectomizado / Assessment of degree of psychological health involvement in pre-laryngectomized patients

Introducción y objetivos: Diferentes autores han puesto en evidencia el aumento de ansiedad en los pacientes el día anterior a una intervención y su correlación con los niveles de ansiedad en el post-operatorio. En este trabajo estudiamos una serie de problemas que a menudo se obvian en el paciente intervenido de laringectomía total: la traqueotomía, el quedarse sin voz y el ser una agresiva e importante intervención quirúrgica. Nuestro objetivo es valorar el grado de ansiedad y los miedos del paciente previo a la laringectomía total. Material y métodos: Se comparan 2 grupos de 20 pacientes que fueron intervenidos de laringectomía total y de otras enfermedades de ORL. El día anterior a la operación, recogíamos sus datos sociodemográficos y médico-quirúrgicos, y se les aplicaba el Mini-Examen Cognoscitivo (MEC) de Folstein y el Cuestionario de Salud General de Goldberg (GQH-28) en sus versiones españolas. Exploramos si tenían algún temor o miedo ante la intervención y en qué consistía ese miedo. Resultados: Tras la realización del MEC, sólo un paciente presentó deterioro cognitivo. Posteriormente realizábamos el GHQ-28 y nos encontramos con un malestar psicológico entre el 20y el 25% de los casos. Al comparar mediante el X2 los diferentes miedos en los 2 grupos los resultados no son estadísticamente significativos. Conclusiones: La laringectomía total provoca la pérdida de la comunicación oral y la distorsión de la autoimagen, lo que contribuye a una fuerte alteración emocional. Es necesaria una rehabilitación efectiva, que considere todos los aspectos relacionados con el proceso salud enfermedad desde antes de la cirugía como la recuperación del lenguaje hablado, los aspectos sociales y sus características psicológicas, las cuales son vitales para el adecuado manejo integral del paciente (AU)

Introduction and objective: Several authors have found increased anxiety in patients the day before an intervention and its correlation with anxiety levels the post-operative period. In this study, we determined a number of problems to which patients who underwent total laryngectomy often objected: the tracheostomy, being left without a voice and it being an aggressive, major surgery. Our objective was to assess the degree of anxiety and fears of the patient prior to total laryngectomy. Material and methods: We compared 2 groups of 20 patients who underwent operation for total laryngectomy and for other ENT pathologies. On the day before the operation, we collected demographic and medical data and administered the Spanish versions of the Folstein Mini-Mental State Examination (MMSE) and the Goldberg General Health Questionnaire (GHQ-28). We also investigated whether the patients had any fear or fear of surgery and what that fear was. Results: Completion of the MMSE revealed cognitive impairment in only one patient. We subsequently conducted the GHQ-28 and found psychological distress in 20-25% of our cases. When the different fears in both groups were compared by X2, the results were not statistically significant. Conclusions: Total laryngectomy causes the loss of oral communication and impairs self-image, contributing to a strong emotional reaction. It is essential to have effective rehabilitation, which considers all aspects of health-sickness, such as the recovery of spoken language, social aspects and the psychological characteristics, vital for proper comprehensive patient management (AU)

[Assessment of degree of psychological health involvement in pre-laryngectomized patients]. / Valoración del grado de afectación sobre la salud psíquica en el paciente prelaringectomizado.

INTRODUCTION AND OBJECTIVE: Several authors have found increased anxiety in patients the day before an intervention and its correlation with anxiety levels the post-operative period. In this study, we determined a number of problems to which patients who underwent total laryngectomy often objected: the tracheostomy, being left without a voice and it being an aggressive, major surgery. Our objective was to assess the degree of anxiety and fears of the patient prior to total laryngectomy. MATERIAL AND METHODS: We compared 2 groups of 20 patients who underwent operation for total laryngectomy and for other ENT pathologies. On the day before the operation, we collected demographic and medical data and administered the Spanish versions of the Folstein Mini-Mental State Examination (MMSE) and the Goldberg General Health Questionnaire (GHQ-28). We also investigated whether the patients had any fear or fear of surgery and what that fear was. RESULTS: Completion of the MMSE revealed cognitive impairment in only one patient. We subsequently conducted the GHQ-28 and found psychological distress in 20-25% of our cases. When the different fears in both groups were compared by X(2), the results were not statistically significant. CONCLUSIONS: Total laryngectomy causes the loss of oral communication and impairs self-image, contributing to a strong emotional reaction. It is essential to have effective rehabilitation, which considers all aspects of health-sickness, such as the recovery of spoken language, social aspects and the psychological characteristics, vital for proper comprehensive patient management.

Utilidad del material sustitutivo óseo en la cirugía del implante coclear, base de cráneo y senos paranasales: nuestra experiencia / Utility of bone replacement material in cochlear implant, skull base and sinus surgery: Our experience

Introducción: Para solucionar determinados problemas que nos surgen en la cirugía del implante coclear, de los senos paranasales y de la base de cráneo hemos introducido en nuestro servicio el uso de un cemento óseo (PolyBone®). Con el objetivo de lograr la elaboración de cementos óseos de uso quirúrgico, la unión de factores de crecimiento óseo y polifosfatos ha permitido el estudio de estos materiales biológicos. Material y resultados: Presentamos un total de 28 pacientes con edades comprendidas entre 2 y 69 años, y una edad media de 29,2 años en los que el PolyBone® nos ha servido como un arma terapéutica más en el área quirúrgica de la ORL. En dos de los pacientes (7,4%) aparecieron complicaciones. Una menor que solucionamos con tratamiento conservador y una complicación mayor, que requirió una cirugía de extracción del material y explantación del implante. En los otros 26 (92,6%) pacientes se obtuvieron excelentes resultados. Conclusiones: Existen diferentes materiales autólogos y aloplásticos que nos sirven de gran utilidad para el manejo de fístulas, relleno de cavidades, u obliteración de senos entre otros. El cirujano debe conocer las propiedades biológicas, características fundamentales, técnica de obtención y posibles aplicaciones quirúrgicas para ser capaz de prevenir futuras complicaciones. Entre estos materiales, el cemento óseo (PolyBone®) es una alternativa eficaz a tener en cuenta en el manejo quirúrgico de nuestra patología (AU)

Introduction: To solve certain problems that arise in cochlear implant, sinus and skull base surgery, the use of bone cement (PolyBone®) has been introduced in our department. With the goal of making use of surgical bone cements, combining bone growth factors and polyphosphates has allowed the study of these biological materials. Materials and Results: We present a total of 28 patients aged between 2 and 69 years (mean age of 29.2 years) in whom PolyBone® has been used as an additional therapeutic tool in the ENT surgical area. Complications occurred in 2 patients (7.4%). One was minor, solved with conservative treatment; one was a major complication that required surgery to extract the material and remove the implant. In the other 26 patients (92.6%), excellent results were achieved. Conclusions: Different autogenous and alloplastic materials are of great utility for fistula management, cavity filling or sinus obliteration, among other uses. The surgeon must understand their biological properties, fundamental characteristics, production technique and potential surgical applications to be able to prevent future complications. Among these materials, bone cement (PolyBone®) is an effective alternative that should be considered in surgical management of ENT pathology (AU)

[Utility of bone replacement material in cochlear implant, skull base and sinus surgery: our experience]. / Utilidad del material sustitutivo óseo en la cirugía del implante coclear, base de cráneo y senos paranasales: nuestra experiencia.

INTRODUCTION: To solve certain problems that arise in cochlear implant, sinus and skull base surgery, the use of bone cement (PolyBone®) has been introduced in our department. With the goal of making use of surgical bone cements, combining bone growth factors and polyphosphates has allowed the study of these biological materials. MATERIALS AND RESULTS: We present a total of 28 patients aged between 2 and 69 years (mean age of 29.2 years) in whom PolyBone® has been used as an additional therapeutic tool in the ENT surgical area. Complications occurred in 2 patients (7.4%). One was minor, solved with conservative treatment; one was a major complication that required surgery to extract the material and remove the implant. In the other 26 patients (92.6%), excellent results were achieved. CONCLUSIONS: Different autogenous and alloplastic materials are of great utility for fistula management, cavity filling or sinus obliteration, among other uses. The surgeon must understand their biological properties, fundamental characteristics, production technique and potential surgical applications to be able to prevent future complications. Among these materials, bone cement (PolyBone®) is an effective alternative that should be considered in surgical management of ENT pathology.